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NPI Code Detail

MEDICARE: COURTNEY NICOLE WILSON NP

MEDICARE: COURTNEY NICOLE WILSON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.020089IL
2363LF0000XFamily Nurse PractitionerA155984IA

General Provider Information

NPI Number : 1407403348
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY NICOLE WILSON NP
Provider Business Mailing Address
First Line : PO BOX 735379
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5379
Country : US
Telephone Number : 563-340-3782
Fax Number : 563-204-4474
Provider Business Practice Location Address
First Line : 1130 W 53RD ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52806-2401
Country : US
Telephone Number : 563-340-3782
Fax Number : 563-204-4474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2019
Last Update Date : 03/13/2024

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